Disab/WC Nurse CM I

Horizon BCBSNJ employees must live in New Jersey, New York, Pennsylvania, Connecticut or Delaware

Job Summary:

• Performs initial and ongoing review with employees/claimants, coordinates medical care, and communicates with providers, clients, and attorneys as needed.

• Authorizes inpatient and outpatient services, and reviews bills for appropriateness utilizing HCS guidelines.

• Utilizes network providers to ensure appropriate treatment and services, where applicable.

• Documents all activities on existing claims systems including describing progress, treatment, and recommendations for the ongoing case management according to HCS and client guidelines.

• Attends in-services, seminars and meetings to maintain current knowledge level and licensure requirements.

• Requires on-call coverage, on an as needed basis.

• Performs other duties as assigned by management.

Disclaimer:
This job summary has been designed to indicate the general nature and level of work performed by colleagues within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities, and qualifications required of colleagues assigned to this job.

• High School Diploma/GED required.

• Prefers a minimum of two (2) years clinical experience.

• Prefer minimum of one (1) year experience in medical/surgical, occupational medicine, rehabilitation, orthopedics, neurology and/or Workers Compensation or PIP experience.

• Requires a current New Jersey RN License.

• Prefers case management certification.

• Prefer understanding of case management philosophy and process.

• Requires knowledge of health care delivery system.

• Must be proficient in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Lotus Notes; Should be knowledgeable in the use of intranet and internet applications.

• Customer Focus

• Communication & Organizational Skills

• Problem Solving

• Adaptability/Flexibility

• Interpersonal & Client Relationship Skills

• Teamwork

Salary Range:

This compensation range is specific to the job level and takes into account the wide range of factors that are considered in making compensation decisions, including but not limited to: education, experience, licensure, certifications, geographic location, and internal equity. This range has been created in good faith based on information known to Horizon at the time of posting. Compensation decisions are dependent on the circumstances of each case. Horizon also provides a comprehensive compensation and benefits package which includes:

• Comprehensive health benefits (Medical/Dental/Vision)

• Retirement Plans

• Generous PTO

• Incentive Plans

• Wellness Programs

• Paid Volunteer Time Off

• Tuition Reimbursement

Horizon Blue Cross Blue Shield of New Jersey is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, protected veteran status or status as an individual with a disability and any other protected class as required by federal, state or local law. Horizon will consider reasonable accommodation requests as part of the recruiting and hiring process.